Provider Demographics
NPI:1912228388
Name:GREGSTON, CHRISTOPHER T (MSW, LCSW UNDSPV)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:T
Last Name:GREGSTON
Suffix:
Gender:M
Credentials:MSW, LCSW UNDSPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 N LARK ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2331
Mailing Address - Country:US
Mailing Address - Phone:580-302-3707
Mailing Address - Fax:
Practice Address - Street 1:2250 W MODELLE AVE
Practice Address - Street 2:SUITES A & B
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3749
Practice Address - Country:US
Practice Address - Phone:580-302-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health